{"id":138835,"date":"2025-04-04T22:51:45","date_gmt":"2025-04-05T02:51:45","guid":{"rendered":"https:\/\/cardiologynownews.org\/?p=138835"},"modified":"2025-04-04T22:51:45","modified_gmt":"2025-04-05T02:51:45","slug":"altshock2-no-benefit-to-iabp-in-hf-cardiogenic-shock","status":"publish","type":"post","link":"https:\/\/cardiologynownews.org\/?p=138835","title":{"rendered":"Altshock2: No Benefit to IABP in HF-Cardiogenic Shock"},"content":{"rendered":"<p><span style=\"font-weight: 400;\">Key Points:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Prior trials have demonstrated limited benefit to intra-aortic balloon pump (IABP) use in acute myocardial infarction-related cardiogenic shock, but the role of IABP in heart failure-related cardiogenic shock (HF-CS) is not yet clear.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">The ALTSHOCK2 trial was designed to examine the utility of early IABP implantation in improving the primary endpoint of 60-day survival or bridge to heart replacement therapy (HRT) in HF-CS.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">There was no difference in the primary endpoint between early IABP and standard of care treatment.<\/span><\/li>\n<\/ul>\n<p><!--more--><\/p>\n<p><span style=\"font-weight: 400;\">Cardiogenic shock mortality remains up to 50%, despite increasing utilization of temporary mechanical circulatory devices. Since the negative IABP-SHOCK II trial, intra-aortic balloon pump (IABP) use is no longer routinely recommended in acute myocardial infarction-related cardiogenic shock, but the role of IABP in heart failure-related cardiogenic shock (HF-CS) is not yet clear. In fact, small studies in HF-CS have so far demonstrated potential improvement in hemodynamic parameters as well as bridging to heart replacement therapy (HRT), but large-scale trials are lacking. In a breaking presentation at the 2025 ACC Scientific Sessions today, <\/span><a href=\"https:\/\/esc365.escardio.org\/person\/49807\"><span style=\"font-weight: 400;\">Dr. Alice Sacco<\/span><\/a><span style=\"font-weight: 400;\"> and her team presented their study: \u201cEarly Intra-Aortic Balloon Pump in Heart Failure Cardiogenic Shock: a Randomized Trial,\u201d or the Altshock-2 study, which was simultaneously published in <\/span><a href=\"https:\/\/www.jacc.org\/doi\/10.1016\/j.jacc.2025.03.003\"><span style=\"font-weight: 400;\">JACC.<\/span><\/a><\/p>\n<p><span style=\"font-weight: 400;\">The Altshock-2 trial <\/span><a href=\"https:\/\/clinicaltrials.gov\/study\/NCT04369573\"><span style=\"font-weight: 400;\">(NCT04369573)<\/span><\/a><span style=\"font-weight: 400;\"> was a multi-center trial based in Italy that randomized 101 adults (age 18-75) with a diagnosis of SCAI B-D HF-CS to IABP vs conservative, standard of care therapy. Relevant exclusion criteria were septic shock, severe peripheral vascular disease, post-surgical CS, chronic end-organ dysfunction, and &lt;1 year prognosis. Patients were randomized to early IABP immediately after randomization vs conservative care; escalation was considered at eight hours if five of eight pre-specified clinical and laboratory criteria (HR 60-100, MAP &gt;65 mmHg, SvO2 &gt;60%, PaO2 &gt; 60mmHg, lactate &lt;3.1 mmol\/L, CWP &lt;18mmHg or E\/E\u2019&lt;14, VIS &lt;20, and diuresis &gt; 0.5ml\/kg\/hr) were not met. The primary outcome was 60-day survival or successful bridge to HRT. Secondary outcomes included 60-day survival, 60-day need for renal replacement therapy, maximum IS, maximum duration of vasoactive therapy, and maximum SOFA score.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">A total of 48 individuals were randomized to standard care, and 53 to the IABP group; eight individuals (17.2%) were escalated to MCS after randomization in the standard of care arm, and four (7.5%) to an Impella or VA-ECMO in the IABP group. On average, patients were randomized 2.5 hours after CCU admission and 10.5 hours after symptom onset. The median age was 60, with 15% women, 61% non-ischemic cardiomyopathy, 56% SCAI C, and a mean LVEF of 19%. Prior to randomization, 67% of individuals were already on inotropic agents, and 44% already had a Swan-Ganz catheter in place.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">In the intention-to-treat analysis, there was no significant difference in the primary outcome between the early IABP and standard of care arm (HR 0.72, 95% CI 0.31-1.68; p=0.45). In subgroup analyses, no differences were observed by sex, age, time from symptom onset, LVEF, SCAI stage, or lactate (all p-interaction &gt;0.05). Similarly, in secondary analyses, no differences were observed in 60-day survival, 60-day need for renal replacement therapy, maximum IS, maximum duration of vasoactive therapy, and maximum SOFA score. In the IABP group, there was a numerically higher risk in bleeding (17 vs 8.3%), vascular complications (7.5 vs 0%), and limb ischemia (3.8 vs 0%) that did not reach statistical significance.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">When discussing the clinical implications of the study at the Scientific Sessions, Dr. Sacco stated: \u201cEarly IABP implantation does not improve 60-day survival in HF-CS compared to inotropic therapy\u2026IABP should be considered after failure of inotropes.\u201d<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Key Points: Prior trials have demonstrated limited benefit to intra-aortic balloon pump (IABP) use in acute myocardial infarction-related cardiogenic shock, but the role of IABP in heart failure-related cardiogenic shock (HF-CS) is not yet clear. The ALTSHOCK2 trial was designed to examine the utility of early IABP implantation in improving the primary endpoint of 60-day [&hellip;]<\/p>\n","protected":false},"author":40603,"featured_media":138836,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[898,8],"tags":[899,45,47,185],"ppma_author":[1029],"class_list":{"0":"post-138835","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-acc-2025","8":"category-news","9":"tag-acc-2025","10":"tag-conference","11":"tag-featured","12":"tag-news","13":"author-leah-kosyakovsky"},"authors":[{"term_id":1029,"user_id":40603,"is_guest":0,"slug":"leah-kosyakovsky","display_name":"Leah Kosyakovsky","avatar_url":"https:\/\/secure.gravatar.com\/avatar\/864bde69f6f1f80e91e4a97f0a0ba8daa64c2bb702be09ed787444c7dfa045bb?s=96&r=g","0":null,"1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":""}],"_links":{"self":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/138835","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/users\/40603"}],"replies":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=138835"}],"version-history":[{"count":1,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/138835\/revisions"}],"predecessor-version":[{"id":138837,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/138835\/revisions\/138837"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/media\/138836"}],"wp:attachment":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=138835"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=138835"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=138835"},{"taxonomy":"author","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fppma_author&post=138835"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}